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15% Prevalent HD patients at Home is realistic

This article discusses the prevalence of home hemodialysis (HHD) among HD patients, factors contributing to the decline of HHD, and reasons to reinvest in HHD. It also highlights the benefits of HHD, including improved dialysis outcomes and greater patient control over treatment. The article concludes with information about an upcoming conference on home dialysis.

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15% Prevalent HD patients at Home is realistic

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  1. 15% Prevalent HD patients at Home is realistic Dr R N Greenwood Lister Renal Unit, Stevenage RA CD Forum, March 08

  2. Acknowledgements • Slides 20-25; Dr John Ager, Consultant Nephrologist Geelong, Melbourne, Australia • Slides 26 & 27 Dr Sandip Mitra, Consultant Nephrologist Manchester Royal Infirmary

  3. The Decline of HHD 1980 – 2000Mitigating Factors • Wholesale reduction in dialysis time to <4hrs • CAPD • Capital-free home therapy • Improving transplant outcomes • Johnny come lately – satellites • Outside UK – HD privatisation

  4. Centre HD Home HD PD Source: USRDS – AJKD Jan 2008; data from 2005

  5. The prevalence of different renal replacement modalities in 21 high-income countries MacGregor, M. S. Nephrol. Dial. Transplant. 2006 21:1934-1945; Data predominantly from 2003

  6. Trends in International HHD MacGregor, Agar and Blagg Nephrol Dial Transplant (2006)

  7. Rate of Home Haemodialysis Rate of HHD by hubs … as % of all dialysis (both HD + PD)

  8. Brit Med Jour, January 08 • C Blagg (Editorial) – Home Haemodialysis – wide variations in availability exist, and the UK lags behind some othere countries • C Tomson (Letter) – UK Nephrology misunderstood • D Ansell (Letter) – Missing facts, different countries

  9. 75 Source: World Bank 2003

  10. Reasons to Re-invest in HHD • Grave messages from the HEMO trial • Fossilisation of Facility HD • Tariff based on minimalist treatment (3x4) • Reimbursement systems (PbR) • Wholesale privatisation of HD • HHD most practical route to giving more dialysis • Dialysis on the move – new technology Motivated patients need to control their own treatment and the freedom to access more dialysis

  11. HEMO Trial: Time to death by Kt/V groups

  12. 4D Study: Primary composite endpoint (death from cardiac causes, nonfatal myocardial infarction, and stroke) Relative Risk Reduction 8 % (95 % CI: 0.77-1.10, P=0.37) 60 Median follow-up time of 4 years 50 40 Cumulative incidence (%) 30 Placebo 20 Atorvastatin 10 0 0 1 2 3 4 5 5.5 years Years from Randomization Placebo 636 532 383 252 136 51 29 Atorvastatin 619 515 378 252 136 58 19 Wanner et al NEJM 2005; 353:238-248

  13. Monday, Bloody Monday: Excess Mortality in HD patients

  14. Method and Location of Dialysis 2001 - 2006 Australia Number of Patients

  15. Extended Hour and/or Frequency(% Total Haemodialysis Patients - Australia) From ANZDATA

  16. HD Frequency (per week) Australia 1996 – 2006 By Haemodialysis Location Percentage >= 3.5 times per week Survey

  17. HD Session Length Australia 1996 – 2006 By Haemodialysis Location Percentage >= 6.5 hours per session Survey

  18. Duration of HD (per week) Australia 1996 – 2006 By Haemodialysis Location Percentage >= 18 hours per week Survey

  19. The Victorian Maintenance Dialysis Program • VICTORIA • South-eastern corner of Australia • Smallest mainland state • but … • The most densely populated • The most urban • Population  = 5,188,100 • Population Density= 22.47/km² = 58.2 /sq mi NB: (1) Victoria is similar in land mass and population density to Minnesota (2) Most HHD patients live in urban areas, NOT in rural communities

  20. New funding model 2007/08 compare http://www.dhs.vic.gov.au/health/renaldialysis/funding.htm All $’s rounded to nearest 100

  21. New funding model 2007/08 ↑1.5%↑26% http://www.dhs.vic.gov.au/health/renaldialysis/funding.htm All $’s rounded to nearest 100

  22. New funding model 2007/08 http://www.dhs.vic.gov.au/health/renaldialysis/funding.htm All $’s rounded to nearest 100

  23. New funding model 2007/08 http://www.dhs.vic.gov.au/health/renaldialysis/funding.htm All $’s rounded to nearest 100

  24. So … on 20/2/08, DHS(V) corrected this anomaly to a more equitable home ‘split’ http://www.dhs.vic.gov.au/health/renaldialysis/funding.htm All $’s rounded to nearest 100

  25. UK - Manchester Royal Infirmary

  26. Home HD as preferred modality in predialysis (MRI)Choice best offered in predialysis phase Predialysis Patient numbers accepting Home HD eGFR < 10 16 patients ( 83% have access fashioned ) eGFR 10 – 20 24 patients

  27. 15% Prevalent HD patients at Home is realistic Experience of enthusiasts in Australia, British Columbia, Finland and UK supports this Conference on Home Dialysis Manchester, Oct 2nd and 3rd 2008

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